AB1824-HPR MULTIPLE TNFI TREATMENT CYCLES AND THE FAILURE OF TRIAL-AND-ERROR CARE FOR PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: S. Helfgott, C. Adams, A. Frick, K. Huston, S. Milligan, J. Singh, N. Soloman, C. Edgerton
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Inhibitors of tumor necrosis factor-alpha (TNFi) are central to management of rheumatoid arthritis (RA) though continued use beyond initial failure is negatively associated with response to subsequent TNFi treatment. <h3>Objectives</h3> To assess the patterns of recurrent TNFi use relative to reasons for switch as observed in community rheumatology care in the US. <h3>Methods</h3> Data: PIONEER-Rheumatology, an EMR and open text-extracted database specific to care given by the American Rheumatology Network (ARN). Study population: Adult (18+ years old) patients with RA, TNFi-treated in 2018 to 2021. Full histories were assessed for each patient and index was set as the initiation date of the last TNFi observed for each patient prior to 2022. Reasons for discontinuation were extracted from chart notes and broadly classified (and subclassified) as attrition (death, moved/left practice, non-clinical reasons), lost to follow up (LTFU, patient disengaged), or clinical (treatment goal achieved, lack/loss of efficacy, or condition resulting from disease, treatment, or patient burden). <h3>Results</h3> 13994 patients and 19925 episodes (defined as distinct patient &amp; TNFi drug) were examined. Of 13944 patients, 9399 (67%) received 1 TNFi, 3527 (25%) 2 TNFi, 1068 (8%) ≥3 TNFi; treatment patterns may have included intervening non-TNFi treatment cycles. [TABLE] <h3>Conclusion</h3> A third of TNFi-treated study patients received &gt;1 TNFi with most discontinuing prior TNFi due to lack/loss of efficacy. Though trial-and-error care is seemingly standard to RA management, this study suggests that some patients do not benefit from this approach. <h3>Reference</h3> [1] Helfgott S, Huston K, Singh J, Soloman N, Broestl J, Cox K, Milligan K, Edgerton C. Development of the Patient-Important Outcomes Data Repository (PIONEER) for Rheumatic Diseases; An Enhanced Database Combining Electronic Medical Data with Insight from Chart Reviews [abstract]. Arthritis Rheumatol. 2022; 74 (suppl 9). https://acrabstracts.org/abstract/development-of-the-patient-important-outcomes-data-repository-pioneer-for-rheumatic-diseases-an-enhanced-database-combining-electronic-medical-data-with-insight-from-chart-reviews/. Accessed January 3, 2023. [2] Kleinert S, Tony HP, Krause A, et al. Impact of patient and disease characteristics on therapeutic success during adalimumab treatment of patients with rheumatoid arthritis: data from a German noninterventional observational study. Rheumatol Int. 2012;32(9):2759-2767. [3] Wijbrandts CA, Tak PP. Prediction of Response to Targeted Treatment in Rheumatoid Arthritis. Mayo Clin Proc. 2017 Jul;92(7):1129-1143. <h3>Acknowledgements</h3> This study was supported by Scipher Medicine. <h3>Disclosure of Interests</h3> Simon Helfgott: None declared, Christopher Adams: None declared, Andrew Frick Grant/research support from: GSK, ViiV, AbbVie, AstraZeneca, Scipher, UCB, Takeda, JNJ, Horizon, Gilead, Merck, Kent Huston: None declared, Scott Milligan Grant/research support from: GSK, AbbVie, AstraZeneca, Scipher, UCB, Takeda, JNJ, Horizon, Gilead, Jasvinder Singh Consultant of: Scipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs Inc., Adept Field Solutions, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, Practice Point Communications, National Institutes of Health, American College of Rheumatology, Zimmer Biomet Holdings, Intuitive Surgical Inc./Philips Electronics North America, TPT Global Tech, Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics Inc., Seres Therapeutics, Tonix Pharmaceuticals Holding Corp, Charlotte's Web Holdings, Inc., Amarin, Viking, Moderna Pharmaceuticals, Simply Speaking, Outcomes Measures in Rheumatology (OMERACT), Nehad Soloman Speakers bureau: AbbVie/Abbott, Horizon, Janssen, Amgen, GlaxoSmithKline (GSK), AstraZeneca, Exagen, UCB, Consultant of: Novartis, Grant/research support from: AbbVie/Abbott, Horizon, Janssen, Amgen, Colin Edgerton Consultant of: Novartis and Boehringer Ingelheim.